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PERMITTEE NAME/ADDRESS pndude Faeilim Nome/Loranon IjDi[(ercm) <br />N MME SENY.CA COAL CCt FANI <br />ADDRESSU P.Aii%8 D <br />HAIDEN CU 81639 <br />FACILITY <br />LOCATIONJAIDEN CU b16.30 <br />ATTN: l:. eU0 tiRU46_ CEMEAAL MA[:ACFA <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDESJ <br />DISCHARGE MONITORING REPORT (DMR; <br />f2-16) (1]- 9) <br />CUOCUI7' D 4 A <br />PERMIT NUMBER DISCHARGE NUMBER <br />"',:.MONITORING PERIOD <br />YEAR~;~MOR;.~DAY YEAR MO DAY <br />FROM ':~C--~~; ~ U 1 TO y y U 5 1 <br />~(i02i1~~~~23) (~d~251 fZ62]1 fZ8~29/ (30.'11) <br />Form Approved. <br />"1I Y O N OMB No. 2040.0004+ <br />Approval expires 05-37-98 <br />(SUER i1) <br />F - fIA11 eUU77 <br />OISCNAI;4E TG 516E CFEEY <br />~~~ MU IiSC6AfiGE ~~) ~~; <br />NOTE: Read Instructions before "completing this form. " <br /> (3 Cerd Onry/ QUANTITY OR LOADING (<Certl Onry) QUANTITY OR CONCENTRATION NO. FREOUENC SAMPLE <br />PARAMETER (4x53) (5a-slJ (3B~d5) (4s-5G) (5•+~srJ EX of TYPE <br />(32-37) AVERAGE MAXIMUM UNITS 'MINIMUM AVERAGE MAXIMUM UNITS <br />r6z 63i ANaLVS15 <br />(sa-sa <br />69-70) <br />UIL AYD GNEASE SAMPLE a~oaa'~r ( 94) #A#aaa aaaaaa ~:aL9a <br />Y 15 U A L MEASUREMENT <br />~ <br />84666 1 U U .'PERMIT #marvwer <br />~ EELQ©A~; <br />.I 15=1 `~ O u: tR#*~=4 o aac 6 iCIE/ ~ ISCAI <br />EFFLUENT CROSS YAL4E .aEquwEMENy; ~. r - <br />~~I~j~,~,~~ 3C=0 ~ ;`~~~ ,~`~`~~~~~; ~a;z dCY1~R <br /> SAMPLE <br /> MEASUREMENT <br /> - PERMIT-"- - - <br />3 d ` ~t <br /> REQUIREMENT <br />- <br />- <br />, <br />,~ <br />~ " ; - <br />- <br /> SAMPLE " ~-" <br /> MEASUREMENT <br /> PERMIT" - <br />~ - <br />~~~~" ,,, „y~: <br />~ + ~ <br />~ . <br /> ~REOUIREMENT ~~~, , <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT' ~.~a: '";t?.; ,...,.::"-.t <br />' - <br />- " <br /> REQUIREMENT - -- v It ~~~ <br />` _- <br />' <br /> SAMPLE <br /> MEASUREMENT <br /> 'PERMIT - ~ - '~ ~~. ~ - ~ ~'- I ~ '~" <br />~ - ~= - <br /> . <br />~REOUIREMENT - <br />v <br />~~'" ~~ ~ ~ ` ' <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMI-T? - " - . <br />" ~ ,i e ~r ~ .. <br />;a _t <br /> REOUIREAAENT. ~ ".. .. . <br />,~ „Yt~ y {1~.` r ti <br />'~. r- ~ 3i., <br /> SAMPLE <br /> MEASUREMENT <br /> -PERMIT' - <br />' - _ ~ =~' <br />~ "~, ,, <br /> REQUIREMENT ~ ~ <br />4 <br />_ <br />ne <br />r, _ <br />~ <br />r -" <br />.Y.. <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CERTI FY UNDER PENALTY OF LAW THAT I HAVE PERSONALLY E7(AMINED AND TELEPHONE DATE <br /> AM FAMILIAR Wm1 THE INFORMATION SUBMITTED HEREIN; AND BASED ON MV <br /> INQUIRY OF THOSE INDNIDUALS IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> THE INFORMATION, I BELIEVE THE SUBMITTED INFORMATION IS TRUE, <br /> <br />ACCURATE AND COMPLETE. 1 AM AWARE THAT THERE ARE SIGNIFICAM / <br /> <br />PENALTIES FOR SUBMITTING FALSE INFORMATION. INCLUDING THE <br />" ~ '~ ' <br /> POSSIBILRY OF FINE AND IMPRISONMEM. SEE I6 U.S.C. § 1001 AND 33 U B C. SIGNATURE OF PRI CIPAL E%ECUTIVE <br /> <br />TYPED OR PRINTED 4 t319 (Peretties udder these smtures may Include lines up (a 510,000 entl ar <br />maximum imprisonment of behveenbmonlhs entl5yreers.l OFFICER OR A NORIZED AGENT <br />co <br />NUMBER <br />YEAR <br />MO <br />DAY <br />GUMMtN 15 ANU tXYLANA I IUN Uh ANY VIULA I IUNS (Hete]en0e 9119[reORmenrs Hale) <br />155 G IROY LIMITS N1I1 HF: YAIYEL E SETTLEA8IY SCL7L5 LIMIT APPLIED PG6 <=l0IR,24tF FAECII IYE/Z~ T`_S E <br />iRUY LLlIITS IrAIPED ECF ~lUTA~14Nn PAECIP EYEVT SUEJEC7 TC BURUEY OE PFCOP IN I.A.T.- CI1 E 66EA@E - SEE <br />7.R l T1. TOG ^l1YT T('LIYC T-R 1 [ <br />EPA Form 3320.1 (OS-95) Previous editions may not be used. (REPLACES-EPA FORM T-40 WHICH MAY NOT BE USED.) QQ~S1i~ 99 fl E ~ A PAGE ' OF <br />